Your Questions
Your Questions
Q: Dr. Eppley, Hello, you posted several case study about Genioplasty Tightness and dermal fat graft. No where on the internet i can find a review of someone who did the surgery with you. As i’m really interested in getting this procedure done with you, the only person i could find on internet did the same surgery with another doctor based on your study. It didnt work for him and nothing changed and he claim it was due to nerve damage. My questions is, did the dermal fat graft fixed the tightness problem of your costumer
A:I have done that release and graft procedure many times and each patient has gotten some improvement, some more than others. But the key is adequate release and a dermal-fat graft that is big enough to fill the released space.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I had a sliding genioplasty of 5mm forward 8 weeks ago. My face was already long, which I remarked to the surgeon many times, Now my face looks so much longer and I honestly hate the result and wasn’t what I expected at all. A) Is the length of my face going to decrease significantly from here? B) If I decide to move forward with a reversal, is there always laxity, fullness and damage to the soft tissue (I’m only 28 years old)? C) One of my problems is that my lip became thin, is a reversal going to make the lip worse or spoil any chances of the lip getting back to its normal size? Thank you so much, Doctor.
A:In answer to your postop sliding genioplasty questions:
1) What you see at 8 weeks postop is 98% of what the aesthetic outcome will be.
2) With only a 5mm forward movement I would think that the risk of soft tissue laxity with a reversal would be low.
3) A sliding genioplasty reversal is not likely to make the lower lip any thinner…but it wlll also not restore it to its original thickness.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I have an asymmetrical forehead with two bumps, one in height and one in width and one is larger than the other. I would like to know if it is possible to have a completely smooth forehead.
A:What you have are prominent forehead horns, one of which is bigger than the other which creates the major part of the forehead asymmetry. There are two fundamental approaches to your problem:
1) REDUCTION You can reduce the bigger forehead horn to match better to the smaller one but I would doubt you could make both forehead horns completely flat as the thickness of the frontal bones may not permit such an amount of reduction. A CT scan would be needed to make that determination.
2) REDUCTION + AUGMENTATION You can reduce the larger forehead to match the smaller one and then cover the forehead with a thin layer of hydroxyapatite cement to make its contour all even. This would be the only way to make the forehead completely smooth.
Dr. Barry Eppley
World-Renowned Plastic Surgery
Q: Dr. Eppley, I would like the supralateral orbital rim to be addressed but would like to understand the extent to which he can enhance my whole browbone with this approach – is it just the orbital rim or can he go further, is it possible to have a brow bone that goes on my eyebrow or lower down on the holes? I’m not sure what would look aesthetically pleasing . My primary goal is to achieve a deeper-set appearance for my eyes and to have the upper eyelids a lot less visible. My eyes currently appear bulgey and the globe of the eye is visible – I am hoping this approach will create a somewhat masculine appearance slightly too.
Does Dr Eppley know how many millimeters the implant should be to cover over the eyeball? Would this procedure help in concealing the holes in my brow bone (if not it’s not a big deal)? I am also curious if the implant could potentially lower my eyebrows, particularly flattening the arch and shifting them laterally.
A:You have some misconceptions about what a transpapebral brow bone implant can and can not do:
1) It is not a complete brow bone augmentation procedure, it augments the tail or outer half of the brow bone only.
2) Even if the procedure could augment the whole brow bone you can not have that done as there is bone defects across the central brow in which placing an implant over such an area poses a high risk of infection.
3) Short of a bone graft for the central brow bone where the holes are hydroxyapatite bone cement could be used….but never an implant. That, of course, can not be placed through an upper eyelid incision.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Will doing a chin reduction generally cause less sagging than a mandibular angle shave?
A:Chin reduction has a very high incidence of chin pad ptosis dependent upon how it is done. If it is done intraorally (which I would almost never do) then chin pad ptosis is likely to result. If it is done by a submental approach where soft tissue chin pad excision is also done then ptosis does not occur. FYI jaw angel shaves do not cause soft tissue sagging. It is amputation of the jaw angles (traditional V line surgery) where that can be a postop issue.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a bad facelift that changed my jawline completely. The left side is lacking definition and it looks like there was valuable tissue removed.The right side still has some of my jaw left but it to is lacking tissue. There is a nodule on the right where the gonial angle is. When l clinch the masseter muscle it really stands out. I’m not sure why my chin looks bulbous now but it could be fat?I would like to send you pics of my face prior to the procedure and you will get a better idea of what l am trying to say.i believe with implants they can fix the symmetry problem and fill out the deficiency issues.
A:Based on previous pictures sent there is a clear ‘jawline’ asymmetry/deficiency it is not clear to me whether a bone procedure will adequately address a soft tissue created problem…as there is no a 1:1 ratio of bone augmentation to soft tissue change and it would be difficult to accurately what is the needed augmentation even of there was a 1:1 ratio change as 3D CT scans measure bone and not soft tissue. I am not saying it may not work I am merely pointing the challenges in doing so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: D. Eppley, \ I was wondering in Otoplasty if it is possible to remove some bone from behind the ear in order to put the ear back. The reason being is one ear sticks out and the other is generally pretty flat against the head. I also notice the right side of the skull protrudes out a little bit more. Would this even be otoplasty or would this be along skull reshaping?
A:Skull bone removal is not going to help the ears set back further. That requires cartilage and/or sulcus manipulations. It is the differences in the ear structure as to why one ear sticks out further not the skull bone.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, How much is the treatment to remove the dark eye circles?
A:Don’t think of them as removal but rather as treatment to reduce them. All that can be done is to reduce the undereye hollows which will help reduce their appearance but I doubt will make them go completely away. If the only goal is to reduce the color of the dark circles then this will not be accomplished by surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a somewhat specific question about a nose operation that I have not seen before. It is about putting the nose down so that it no longer looks as if it is connected to the forehead and is no longer so high. Is it possible in any way?Because I have never seen this in any surgery, but this would be really important to me.
A:You are referring to reduction about the high radix (frontal nasal junction ) in rhinoplasty. The high radix nose can be reduced but not the degree that you have imaged due to the location of the frontal sinus and nasal airway cavities.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I recently saw a post about the inferior orbital box osteotomy. I’ve seen the normal orbital box osteotemy but it is too complex and extreme in my opinion. How does the inferior orbital box osteotemy differ from the normal orbital box osteotemy. Can I still expect the same results? I want my Intercanthal distance widened about 5mm and Ipd widened 5mm. Is that possible with the inferior orbital box osteotomy? If not what is the limit on the amount of intercanthal distance and interpupillary distance one can get with the proceducre.
A:Those ICD and IPD changes are likely beyond what an inferior orbital box osteotomy can achieve. While the inferior orbital box osteotomy is a lesser surgery than a full 360m degree orbital box osteotomy as a result it produces less significant changes. (less than 5mms)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, There is a surgeon in Turkey that said they think they can remove my rib hump bilaterally with just doing a 3cm incision to remove rib cartilage, how much of the rib flare could I realistically expect to lose?Would pec implants or a sternum implant WITH pec implants be enough to overcome the mild pectus excavatum?
A:You are referring to subcostal rib flare treatment by subtotal cartilage excision. While this can be effective for some rib flare patients, as an older male with more calcified cartilage and significant rib flare I would be less optimistic as to its effectiveness. If you had to put a percent on it at best I would say a 25% reduction is possible. While some reduction would be achieved it is not going to make a major difference particularly with a mild pectus chest deformity above it.
Ideally you need a diametric approach…meaning augment the chest and reduce the rib flare. (see attached imaging to illustrate the concept) Together that makes each area look better.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was born with bilateral club foot. Surgery was completed when I was 3 months old. I still have thin calf muscles,skinny ankle and short feet which affects my confidence in my personal life. I am 30 years old with no other medical condition. I would like to know more about calf augmentation. Looking forward to hearing from you soon.
A:Compared to many clubfoot patients I have seen you are more favorable for calf implants than some. Your legs below the knees are small but do not appear to be overly tight and constricted. When it comes to lower leg augmentation here are the concepts to know:
1) Calf implants augment the upper half of the lower leg where the gastrocnemius muscle resides, not the whole lower leg. (see attached imaging)
2) Your calf tissues will be tight so implant augmentation is restricted to the medlal gastroc muscle…which is the one that is most seen anyway.
3) Any augmentation below the gastroc muscle to the ankle must be done with fat injection grafting…which has an predictable survival rate but is the only treatment option.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I attached 3 pictures, the cropped one being with my jaw open and the right sided temporalis muscle being significantly smaller. Would this be a possible outcome of the surgery? I’m even open to burring of the lateral aspects of my forehead to help reduce width, if at all possible in my case?
A:You have correctly surmised that the temporal muscle thinning with the jaw wide open is a very good preoperative test of whether temporal reduction would be an effective surgery.
The only comment you made which gives some pasue to this answer is… I’m even open to burring of the lateral aspects of my forehead to help reduce width….as temporal reduction surgery does not affect the bony side of the forehead.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Just wanted to look at the possibility of an online consultation for a masculine forehead augmentation.
A:Wiuth your severely backwards sloped forehead but with good br0w projection you would need a custom forehead implant that looks similar to the attached design. The implant’s objective is to normalize the forehead and top of head skull shape that is more consistent with that of a male.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello, I am interested in getting a custom wrap around implant for my jaw and chin. My overall goal is to have a more defined lower part of my face. I would like to have a more defined jaw line, especially toward the back of my jaw where I have little definition. I would like to extend my chin out to align with the lower lip. Right now I have some filler there but it has never made me happy, I would dissolve it prior to surgery. I am also possibly interested in doing a fat reduction on my cheeks, I have very fully cheeks that make my face look rounder, perhaps with the implant I would not feel the need any more. I was curious as to how the design process works, is it possible to have a photo of you augmented to see what your face would look like with the implant prior to ordering it? Also, could you please provide me with an estimated cost for the implant, and possible fat reduction separately? Thank you so much for your time.
A: There is no technology that currently can take a designed implant and show what it would look like on a patient. That may occur some day but is not yet available. Rather custom implant designing is based on targeted imaging of the patient’s facial pictures from which estimates are made as to what implant dimensions can come close to achieving that effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a sliding genioplasty 4 years ago and I am still struggling my chin is in pain and has complete spasms I get Botox but it’s not lasting more than 7 weeks I don’t know what else can be done my surgeon just sent me to a neurologist they done scans ect and can’t find anything in them My surgeon just says he hasn’t seen this. Before I am desperate is there anything else I can do.
A: This is certainly a very unusual problem after a sliding genioplasty. Given that the procedure requires cutting through and then putting back together the mentalis muscle right at its origin, and then requiring the reattached muscle to be stretched over a longer bone distance (assuming that the chin was lengthened) one can see that is a theoretical source for muscle dysfunction. (although this is done routinuely and the problem of muscle spasm is rarely seen)
While Botox appears to provide some good temporary relief any longer term benefit will require surgical intervention. Surgical options include: 1) reducing the amount of horizontal chin advancement that was done (giving the muscle less length on which two contract) and 2) releasing the muscle introrally and placing an interpositional fat graft. Given the rarity of the problem I can not say which one may be more effective or whether either one would provide assured muscle spasm relief. But anatomically these are surgical remedies that make sense.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I was wondering if it would be possible, in addition to reducing the width of the face through cheekbone reduction, to shave down the frontal part of the zygoma (in red) & augment the midface area (in black) so that they are similar to the below image.
A: You are referring to the combination of cheekbone reduction osteotomies combined with paranasal-maxillary augmentation. That is a synergistic approach to narrowing the width of the lateral midface (cheeks) and increasing central midface projection and can certainly be done.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I want to reduce the appearance of my masculine appearance of my chin and the deep crease, I dislike how long it looks when I smile, and I do want to keep the sharpness with a more soft, feminine approach, kind of like Kylie Jenner.
A: It is important to understand that the chin pictures you have shown are of a dynamic concern (chin pad ptosis) while surgery is a static non-dynamic procedure. Thus the only assured surgical change would be what the chin looks like at rest or in a non-dynamic state. It is from these pictures, front anf side, can only make for a more accurate assessment of what can be done.
Dynamic chin pad ptosis may be improved by static chin reduction procedures. But it is important to point that such dynamic changes are less predictable since the surgery is done in a static moving state.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi, I got a quote from you for a sliding genioplasty about 3 years ago. I currently have a chin implant and feel like a sliding genioplasty will give me the results I am looking for and also allow me to get back into boxing once it’s healed. The left side of my implants wiggles so maybe insurance will pay for anesthesia.
A: That was 3 years ago so costs have changed. (Iincreased) Insurance does not pay for any cosmetic related procedures.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have read up on your good work. I tore my bicep tendon a year ago and didn’t get it fixed. I have a Popeye style muscle with a gap between its end and the elbow. I would like to get an implant to give the size back again.
A: You have correctly surmised that your bicep muscle is now permanently shortened and only an implant can fill in the now contracted distal end. While such an implant to do so is not large consideration has be given to the dynamic change in the muscle end from when the arm is fully extended to when the elbow is bent at 90 degrees or more. Also the overlying soft tissues are not thick and consideration also has to be given to preventing implant migration or revealing its edges through the skin. This is where it is important to encase the implant in a lining that is similar to the fascia that normally surrounds the muscle. For this I use an Alloderm sheet or Galaflex sheet to encase the implant and attach it to the fascia of the muscle end.
The bicep extension implant is made by either measurements you take at home or we can send a moulage kit to make an impression of the missing muscle segment.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Interested in the surgery to fix my flat head. I been dealing with it my whole life. I’m a 27 year old male. And I wanna get this fixed
A: The first place to start is to get some side view pictures of your head to make assessment and then did imaging to see what type of back of head augmentative change you seek.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, yesI am a 25 years old and all my life I had a webbed neck and could not find a solution for it. Two years ago, I did physical therapy for a month, it helped a little bit and my neck got slimmer from the sides, but when I stopped, my neck got back to its usual shape. Sometimes my neck is slimmer, some days it is wider. My neck is not so stiff usually. Here are the pictures, I wonder if there are any solutions for fixing it from both sides, and from the profile, the access skin under my chin. I do feel any pain around my neck, and my concern is that I just want to have a normal and slim neck, like everybody. If there is any more information I can provide, please let me know. Best regards.
A: In webbed neck surgery the improvement it provides is reduction in the visible webbing from the front and back views. I can not say that much aesthetic improvement is seen in the side view where the webs do not cause any major aesthetic visibility. There is going to be benefit in the stiffness or movement of the neck.
Many webbed necks have a shorter chin projection which I think is an effect of the webbed neck. This will not improve by webbed neck surgery alone. It requires some form of concurrent chin augmentation and/or submental liposuction.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I have a barely noticeable dent”on my brow which was caused by microneedling done years ago. (It seems it killed the flesh.) You seem like the brow expert so I was wondering if you had a permanent solution you could perform–an implant? (That’s super thin, only thick enough to smooth out the dent on my brow)
A: Need to see a picture of the brow concern. Since the problem originated from a soft tissue injury it would seem like a soft tissue solution may be more appropriate. (e.g., filler, fat injections) Not that an implant could not be used just an initial insight based on a description of the problem origin.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, I had a car accident about 30 years ago and had tracheostomy done. I have scar from that and want to see if you can provide options to remove it.
A: That trach scar can be improved by total scar excision and closure. But there will always be s acar. The goal of scar revision, which should be called scar replacement, is to have an improvement in its appearance. There is no way to completely get rid of it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hello doctor, I am 2 months after a mandibular advancement + genioplasty and I do not like the result at all because it has lengthened my face. So I want to shorten the bottom of my face, reduce the chin in length and move it back a little + reduce the lower edges of the mandible without touching the angles. However, I am extremely afraid that the soft tissues, muscles, could relax. And therefore end up with a “wizard’s” chin that goes down. And so, I do not know which technique is best for me between shaving or osteotomy. These are slight modifications I think no more than 8mm of reduction in height and maybe 3 of recession. According to you what would be the best technique for me and why? Thank you in advance!
A: Those are big bony changes that are best achieved by redoing the osteotomy not by shaving for the very concern that you have. (tissue sagging)
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, i would like to know how long it takes to get customized chin implant. I would like to enhance my chin to make it look more square and well-defined with just a little more projection. I don’t want anything too dramatic—just a subtle improvement that gives my face better balance. My local doctor uses implants they are more round shaped. I had jaw implants 9 years ago but it make my face so bulky.
A: You have correctly surmised that when you need a very specific facial implant augmentation change you need a custom implant design. Standard facial implants are made for now historiic facial changes which are different today.
Once a have the 3D CT scan it is a 2 to 3 month process to get designed, manufactured, sterilizied and shipped for surgery. This is largely due to the large number of implant cases that in the process at any one time.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Please see attached images of my eye area and CT scans from after orthagnathic surgery. I’m trying to address the under eye volume loss and sunken look. I think it also makes my cheek look flat as well by extension. Not sure if I should pursue under eye filler or just do a Infraorbital rim implant for a more permanent solution
A: Eye filler is useless for a skeletal deficiency. Custom infraorbital implants is what is best since through their rim saddling design they provide the best undereye hollowing correction effect.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Does masseter muscle dehiscence resolve itself if the jaw implants are removed or does the masseter still need to be surgically reattached? Thanks.
A: Masseter muscle dehiscence/retraction will not resolve itself by implant removal altbough its aprpearance may become less.
There is no consistently effective method for masseter muscle dehiscence repair.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Dear Dr. Eppley I recently came across information about your chin asymmetry correction surgery using the bone shaving technique. I have a few questions regarding post-surgery care and maintaining the results: Maintaining Chin Results: Is there anything I should do to maintain the state of my chin in the long term after this type of procedure? Are there any recommendations to avoid potential issues such as sagging skin or asymmetry? Botox Use: Would it be necessary to use Botox in the chin muscles after the surgery to prevent muscle activity issues or asymmetry? Excess Tissue Removal: If further adjustments are needed in the future to correct the chin’s shape, would simply removing excess tissue be sufficient, or would more invasive procedures, such as osteotomy, be required? I would appreciate any recommendations you may have. Thank you in advance for your response. https://exploreplasticsurgery.com/bony-chin-asymmetry-correction/
A: Bony chin asymmetry correction may involve bone removal only or a combination of bone removal and soft tissue removal. Each case has to be evaluated on an individual basis. Either way the procedure is intended to provide a permanent correction. Botox injections are not needed for chin asymmetry correction or maintenance after surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
Q: Dr. Eppley, Hi there, I have two forehead horns/bumps on my upper forhead that I am interested in having burred down. I still want a feminine and more rounded forehead but I just dont like the two asymetrical bumps on the sides (I did have two head injuries as a child that may have caused these). I wanted to know if a) this can be done with two smaller perpendicular incisions rather than along the front of the hair line (I have seen this in some of your photos) and b) is it possible to get this done under local anesthesia with drugs/gas to make me drowsy? I am very hesitant to go under general and have had other surgeries under local + drugs that have worked well. C) do you ever see cases where scar tissue fills in after the bone burring to be just as bad as before or close to? D) do you need x-ray or CT imaging beforehand? Thanks!
A: Forehead horns are congenital frontal eminence developments that have no coorelation to prior forehea trauma. They can be reduced by bone burring and whether they can be fully reduced is a function oif the bone thickness. This is the value of the CT scan to make that preoperative determination. Access to do the procedure can be done using a limited frontal hairline incision. To keep the incision(s) limited it can not be any further back or perpendicular to the hairline as this prohibits the linear access/visibility to do the procedure. I have not yet seen bony forehead horn regrowth nore would expect that to occur.
Local anesthesia is not an option for me to perform it. Patients that need that technique will need to seek out other surgeons who may be willing to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon
